Dr.

Maheshwari Harishchandre
Assistant Professor
M.P.Th (Neurosciences)

DVVPF College of Physiotherapy,

Ahmednagar
 Introduction
 Principles
 Rules of sensory input
 Sequence of Motor Development
 Ontogenic Motor Pattern
 Facilitation Technique
 Inhibition Technique
 Margared Rood (1976)

 PT & OT

 CP & patients with motor control

problems.
1. Controlled use of sensory stimulus.
a. Specific Motor response
b. Normalization of muscle tone
2. Use of Developmental sequences.
a. Sensorimotor development = from lower to higher
level.
3. Use of activity to demand a purposeful response.
4. Practice of sensory motor response is necessary
for motor learning.
1. A fast brief stimulus produces a large synchronous motor
output.
Use : stimulus confirms the reflex are functioning.
2. A fast repetitive sensory input produces a mantained response.
3. A mantained sensory input produces a mantained response.
e.g. Gravity, positions
4. Slow, rhythmical, repetitive sensory input deactivates body &
mind.
e.g. Slow rocking or soft music.
1. Reciprocal Inhibition/Innervation :
 Early mobility pattern protective in nature.
 Phasic & reciprocal type of movement.
 Contraction of agonist & relaxation of
antagonist.
2. Co- contraction :
 Tonic (static ) pattern
 Simultaneous agonist & antagonist contraction.
3. Heavy Work :
 Controlled mobility pattern
 Stock meyer “mobility superimposed on stability”
 Proximal ms. contract & move & the distal segment is fixed.
 E.g. Creeping
4. Skill :
 Highest level of motor control
 Combined Pattern
 Proximal segments are stabilized , distal segments moves
freely. E.g. Typing.
1. Supine withdrawl (Flexion) :
 Total flexion response towards vertebral level T10
 Requires reciprocal innervation with heavy work of
proximal segments.

 Recommended :
a. patients with no reciprocal flexion
b. patients dominated by extensor tone
2. Roll Over towards side lying :
 Mobility pattern for extremities & lateral trunk
muscles

 Recommended :

a. Patients dominated by tonic reflex patterns in

supine
b. Stimulates semicircular canals which activates
the neck & extraocular muscles.
3. Pivot Prone :
 Combined Pattern
 Demands full range of extension of neck, shoulders, trunk &
lower extremities.
 Position difficult to assume & mantain
 Important role in preparation for stability of extensor
muscles in upright position
 Associated with labyrinthine righting reaction of the head
 Integration : STNR & TLRs.
4. Neck Contraction :
 Real stability pattern
 Activates both flexors & deep tonic extensors
 Elicits the tonic labyrinthine righting reaction reaction
when the face is perpendicular to the floor .
 Recommended:
 Patients needs neck stability & extraocular control.
5. Prone on Elbows :
 Stretches the upper trunk musculature
 Influence stability scapular & glenohumeral
regions
 Gives better visibility of the environment
 Allows weight shifting from side to side.

 Recommended :
6. Quadruped Position :
 Lower trunk & LE are in cocontraction.
 Can do weight shifts in forward/backward,
side to side & diagonal directions.
 Mobility superimposed on the stability
 Prepares equilibrium responses.
7. Standing :
 Wt. Is equally distributed on both legs
after that wt. Shifting begins.
 UE are free to perform functions.
 Integration : righting reaction & equilibrium
reactions.
8. Walking :
 Sophisticated process requiring
coordinated movt. Patterns of various
parts of body.
 “support the body weight, mantain
balance, & execute the stepping motion “
– Murray
Tactile Proprioceptive

Light moving Heavy Jt.

Touch Compression

Fast
Stretch
Brushing

Icing
 Stretch
Intrinsic stretch

Resistance

Stretch pressure

Tapping

Vestibular

Vibration

Osteopressure
 Stimulation of
exteroceptors

Causes protective
withdrawl responses

Produces states of
alertness & rapid movt’s of
the limbs.
 Touch is imp. for normal growth &
development ( Montague A, 1978)
 Mechanism
1. Mediated by A delta sensory fibers
2. Stimulates A delta sensory fibers
synapses with fusimotor system reciprocal
innervation ( phasic withdrawl response)
 Effects :
1. Activates low threshold hair end organ & free
nerve endings.
2. Activates sup. mobilizing muscles,
3. Increases corticosteroid levels in the blood
stream.
4. Increases resistance against disease.
5. Improves fluid & electrolyte balance.
Application Frequency Area Response
Finger tips, 3-5 strokes, 30 From the nose to Flexion of UE &
camel hair brush sec. Rest period chin perhaps LE
or cotton swab. between stroke
Light stroking Activates neck
from corner of lip ms. & head tilts
to the cheek laterally towards
the side of the
stimulus.
Light moving Activates
touch to the unilateral flexion
navel or pattern
dermatome T10
in midline to
lateral dirn
To the dorsal Activates a
web spaces of withdrawl pattrn
the fingers & of the extremities
toes
To the tips of the Facilitates a
fingers or soles tickle withdrawl
of the feet response of
great magnitude
Stimulus Mediated by Procedure effect

Fast brushing C fibers By battery operated Lasts for 30

brush is applied minutes, stimulates
over the C fibers which
dermatomes of the sends many
same segment that collaterals in the
supplies the RAS.
ms.(myotome) to be
facilitated.
Eg.
Is applied for 3 to 5
seconds & repeated
after 30 sec.
 Extreme thermal facilitation
 Facilitation of ms activity & ANS responses.
 Uses :
1. Quick icing – hypotonia (3 swipes, blott water after each
swipe)
2. Pressing ice cubes to the skin of dermatome corresponding
to myotome to be stimulated.
3. Ice to stimulate SNS & glandular output of thyroid & adrenal
glands.
Note : cardiac problems.
 Jt. gives control over the motor response.
 Proprioceptors adapt more slowly than
exteroceptors & can produce sustained
postural patterns.
 Defn : Jt. Compression > body wt. applied through the
longitudinal axis of the bone.(Ager J, 1974)
 Causes :
1. cocontraction around jt under compression
2. Combined with ontogenetic patterns s/a prone on
elbows, quadruped, sitting & standing position.
 Can be applied manually or by weighted cuffs or sand
bags.
 It acts on muscle spindle (afferent) & increases

the tone of underlying skeletal muscles.

 Tapping over the belly of muscles with

fingertips

 3-5 times over the muscle to be facilitated.

 Powerful propriocetive input (De Quiros JB)
 Therapeutic Uses :
1. To promote extensor patterns of the neck,
trunk & extremities (Static labyrinthine
system)
2. To elicit subcortical responses, s/a
protective extension
3.To activate antigravity muscles & their
antagonist
4.Fast stimulation s/a rocking stimulates while
rhythmic slow rocking causes relaxation
5.Vestibular stimulation affects tone, balance,
protective responses, bilateral integration &
auditory language development.
 Frequency :
 High Frequency : 100 to 300 cycles/second
 Low frequency : 50 to 60 cycles/second
 Uses :
1. HF is used to elicit tonic vibration reflex which stimulates
contraction of muscle if applied directly over the belly.
2. Inhibits contraction of antagonist ms. & suppress stretch
reflex.
3. LF vibration suppress pain perception, desensitize
hypersensitive skin.
 Defn : presure on bony prominence to

facilitate or inhibit voluntary muscles.

E.g.
1. Gentle shaking or rocking
2. Slow rolling
3. Light jt. compression
4. Tendinous pressure
5. Mantained stretch
6. Rocking in developmental pattern
1. Concise Exercise Therapy : A comprehensive TB for
physical & occupational thearapist by Roshan Mecna
2. Therapeutic Approaches in Neurorehabilitation by
Gajanan Bhalerao
3. Manual Therapy Approaches in neurophysiotherapy
by S. S. Ganvir
4. International Occupational therapy (Sixth edition)m by
Pedretti S.